Improving Performance of IDSR at District and Facility Levels

131 Pages·2007·1.18 MB·English

Partners for Health Reformplus
Improving
Performance of
IDSR at District
and Facility
Levels:
Experiences in
Tanzania and
Ghana in Making
IDSR Operational

September 2006

Prepared by:

Lynne Miller Franco, ScD
University Research Co. LLC

James Setzer, MPH
Abt Associates, Inc.

This document was produced by PHRplus with funding from the US Agency for Kathryn Banke, PhD
International Development (USAID) under Project No. 936-5974.13, Contract No.
Abt Associates, Inc.
HRN-C-00-00-00019-00 and is in the public domain. The ideas and opinions in this
document are the authors’ and do not necessarily reflect those of USAID or its
employees. Interested parties may use the report in part or whole, providing they
maintain the integrity of the report and do not misrepresent its findings or present
the work as their own. This and other HFS, PHR, and PHRplusdocuments can be
viewed and downloaded on the project website, www.PHRplus.org.
Abt Associates Inc.
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Mission

Partners for Health Reformplus is USAID’s flagship project for health policy and health system
strengthening in developing and transitional countries. The five-year project (2000-2005) builds on
the predecessor Partnerships for Health Reform Project, continuing PHR’s focus on health policy,
financing, and organization, with new emphasis on community participation, infectious disease
surveillance, and information systems that support the management and delivery of appropriate
health services. PHRplus will focus on the following results:
Implementation of appropriate health system reform.
(cid:83)
Generation of new financing for health care, as well as more effective use of existing funds.
(cid:83)
Design and implementation of health information systems for disease surveillance.
(cid:83)
Delivery of quality services by health workers.
(cid:83)
Availability and appropriate use of health commodities.
(cid:83)

September 2006
Recommended Citation

Franco, Lynne Miller, James Setzer Kathryn Banke. September 2006. Improving Performance of IDSR at District and Facility Levels: Experiences in

Tanzania and Ghana in Making IDSR Operational. Chevy Chase, MD: The Partners for Health Refpolrums Project, Abt Associates Inc.
For additional copies of this report, contact the PHRplus Resource Center at [email protected] or visit
our website at www.PHRplus.org.

Contract/Project No.: HRN-C-00-00-00019-00

Submitted to: Murray Trostle

and: Karen Cavanaugh, CTO
Health Systems Division
Office of Health, Infectious Disease and Nutrition
Center for Population, Health and Nutrition
Bureau for Global Programs, Field Support and Research
United States Agency for International Development

Abstract
Recognition of the need for effective disease surveillance and response is growing worldwide
due to increased risks of infectious diseases associated with population mobility, globalization, and
emerging and resurging diseases. The Integrated Disease Surveillance and Response (IDSR) strategy,
promoted and supported by the World Health Organization (WHO) Regional Office for Africa
(AFRO), has been adopted throughout the region’s 46 countries to strengthen surveillance systems
such that they inform public health decisions and disease control actions. This document describes the
efforts of the Partners for Health Reformplus (PHRplus) project in Ghana and Tanzania to support
improvements in the performance of IDSR. Ghana and Tanzania sought to address concurrently the
technical, organizational and workforce issues that could impede IDSR performance. The most
notable improvements were seen in reporting, analysis, and interpretation of surveillance data.
Strengthening and maintaining IDSR performance, however, is also dependent the following:
ensuring on-going supervision and follow-up; ensuring IDSR visibility and leadership at all levels;
understanding the links between IDSR and health system decentralization; and addressing structural
barriers to IDSR that are a function of the overall health system.

Table of Contents
Acronyms..............................................................................................................................................ix
Acknowledgments.................................................................................................................................xi
Executive Summary............................................................................................................................xiii
1. Introduction....................................................................................................................................1
2. Integrated Disease Surveillance and Response In Africa: A Key Component of the WHO/AFRO
Strategy to Reduce the Burden of Infectious Disease............................................................................3
3. A Practical Framework for Strengthening IDSR System Performance..........................................7
4. IDSR Implementation in Ghana and Tanzania: Applying the Framework...................................11
4.1 Ghana...................................................................................................................................11
4.2 Tanzania..............................................................................................................................13
5. Approaches and Interventions: Improving IDSR Performance by Addressing Technical,
Organizational and Workforce Determinants at the District and Facility Level..................................17
5.1 Overcoming technical limitations to IDSR performance: defining norms and forms.........22
5.1.1 Ghana...........................................................................................................................22
5.1.2 Tanzania.......................................................................................................................23
5.2 Organizational determinants of IDSR performance: making the system work...................24
5.2.1 Ghana...........................................................................................................................25
5.2.2 Tanzania.......................................................................................................................26
5.3 Improving workforce performance: capacity building and supportive follow-up..............30
5.3.1 Ghana...........................................................................................................................30
5.3.2 Tanzania.......................................................................................................................32
6. Performance in Ghana and Tanzania............................................................................................35
6.1 Ghana – IDSR Performance................................................................................................36
6.2 Tanzania – Results of IDSR Performance...........................................................................38
7. Conclusions..................................................................................................................................45
7.1 Summarizing the Experience...............................................................................................45
7.2 Future of the tools and strategies developed in Ghana and Tanzania..................................46
7.3 Recommendations for strengthening IDSR performance at the district and facility level..47
7.4 Conclusions on broader health systems issues and their impact on IDSR performance.....48
8. Summary and Recommendations for Future Directions in Improving IDSR Performance: the
Need for Health Systems Strengthening...............................................................................................51
Table of Contents vii
8.1 Summary.............................................................................................................................51
8.2 Recommendations for donor assistance..............................................................................52
Appendix 1: Comparison of Priority Diseases
Appendix 2: Results of First Assessment of Factors in Ghana
Appendix 3: IDSR Task Analysis for Ghana
Appendix 4: Norms and Standards for IDSR Data Analysis in Tanzania
Appendix 5: Example of Task Analysis for District Level in Tanzania
Appendix 6: Process of Developing the Tanzania IDSR Capacity Building Package and Content of
Training
Appendix 7: List and Examples of Laboratory Confirmation Job Aids for Tanzania
Appendix 8: Job Aids in Tanzania: District Level Data Interpretation Job Aid
Bibliography
List of Tables
Table 1: Identification of Obstacles and Proposed Solutions.....................................................................18
Table 2: Solutions to Common Problems in IDSR Functioning in Tanzania.............................................28
Table 3: Indicators used to evaluate IDSR performance in Ghana and Tanzania.......................................35
Table 4: Improvements in IDSR Data analysis in Ghana...........................................................................38
Table 5: Comparison of facility level timeliness and completeness results between 8 districts trained in
first two rounds and 4 districts trained last..........................................................................................40
Table 6: Improvements in IDSR Data analysis in Tanzania.......................................................................40
Table 7: Improvement in overall scores during IDSR training in Tanzania...............................................41
Table 8: Adoption and use of IDSR materials in other areas of the countries, as of January 2006............46

List of Figures
Figure 1: Determinants of disease surveillance and response system performance.....................................8
Figure 2: Ghana initial intensive IDSR regions.........................................................................................12
Figure 3: 12 IDSR pilot districts in Tanzania............................................................................................14
Figure 4: Completeness and Timeliness of weekly and monthly IDSR Reporting in Ghana (7 districts in 2
northern regions)..................................................................................................................................37
Figure 5: Completeness and Timeliness of Weekly and Monthly IDSR Reporting from Facilities and
Districts in Tanzania (12 project districts)...........................................................................................39
Figure 6: Example of training effect on reporting in Masasi district, Tanzania.........................................42
Figure 7: Simplified Framework of Factors for IDSR Improvement.........................................................45

viii Table of Contents
Acronyms
CBS Community-based surveillance
CCHP Comprehensive Council Health Plan (Tanzania)
CDC Centers for Disease Control and Prevention
CHMT Council Health Management Team (Tanzania)
ComDAB Communicable Diseases Analysis Book (Ghana)
DHMT District Health Management Team (Ghana)
DMO District Medical Officer (Tanzania)
EDCS Epidemiology and Disease Control Section (Tanzania)
GFATM Global Fund for AIDS, Tuberculosis and Malaria
GHS Ghana Health Service
IDSR Integrated Disease Surveillance and Response
M&E Monitoring and Evaluation
MOH Ministry of Health
NIMR National Institute for Medical Research (Tanzania)
NSU National Surveillance Unit (Ghana)
PHRplus Partners for Health Reformplus project
QHP Quality Health Partners project (Ghana)
RHMT Regional Health Management Team (Ghana and Tanzania)
RHO Regional Health Officer
SCD Standard Case Definition
TOT Training of Trainers
USAID United States Agency for International Development
WHO World Health Organization
WHO/AFRO World Health Organization/African Regional Office
ZTC Zonal Training Centre (Tanzania)

Acronyms ix